Search This Blog

Saturday, March 16, 2019

Bruker Announces Acquisition of Scientific Software Provider Arxspan

Bruker Corporation (Nasdaq: BRKR) today announced that it has acquired Arxspan LLC, a provider of cloud-based scientific software and workflow solutions, based in Southborough, Massachusetts. Arxspan is known for its line of cloud-based products for the management of research data under the Arxlab brand. The company has a focus on serving pharmaceutical and biopharma customers. Financial details of the transaction were not disclosed.
Bruker can now provide a range of software tools for customers in the chemistry, pharmaceutical, biopharma and analytical laboratory markets. Together with the Mestrelab strategic partnership and majority investment, the acquisition of Arxspan will allow Bruker to offer state-of-the-art chemistry and biopharma software tools, supporting discovery and development.
Commenting on the acquisition, Dr. Falko Busse, Group President for Bruker Biospin, stated: “The Arxspan acquisition, coupled with our strategic partnership with Mestrelab, positions Bruker firmly in the field of cloud-based, scientific software for our chemistry and pharma customers. Bruker is committed to providing intuitive end-to-end solutions that make analysis and knowledge extraction in scientific research faster and easier. Our new software solutions enable our biopharma customers to increase their productivity in drug discovery and development.”

Leading scientists, backed by NIH, call for global moratorium on ‘CRISPR babies’

The Chinese scientist who created “CRISPR babies,” He Jiankui, sincerely believed that the research violated neither his country’s laws nor the guidelines of the international scientific community, according to his friends and colleagues. He didn’t exactly keep his experiment secret: He told at least four U.S. scientists that he was considering establishing pregnancies with genome-edited IVF embryos, enlisted a U.S. scientist to work at his Shenzhen lab, teamed with a Chinese hospital and IVF clinic, and proudly announced the birth of “Nana” and “Lulu” on YouTube in November.
Though researchers forcefully condemned He’s work as unethical and a breach of a scientific red line — and while the Chinese government has since accused him of breaking their laws — He clearly hadn’t gotten the memo.
Now, in an effort to prevent another He, 18 scientists from seven countries have called for “a global moratorium on all clinical uses of human germline editing” — that is, changing DNA in sperm, eggs, or early embryos to make genetically altered children, alterations that would be passed on to future generations. They say a moratorium should be in place for at least five years.
In a statement, Dr. Francis Collins, director of the National Institutes of Health, said that “NIH strongly agrees that an international moratorium should be put into effect immediately.”
But even before its publication Wednesday in Nature, the paper had scientists lining up for or against what they call “the M word”: whether a moratorium is the best way to prevent another He without stifling what might one day be a safe and beneficial technology, and even whether a moratorium is currently in place. As Nature editorializes, “so far, there is no sign of a resolution.”
The authors calling for a moratorium include Feng Zhang of the Broad Institute and Emmanuelle Charpentier of Berlin’s Max Planck Institute for the Study of Pathogens, two of the scientists who, separately, led the development of CRISPR for genome editing; Harvard University’s David Liu, who invented a precision form of CRISPR; and Broad director Eric Lander, who was co-chair of President Obama’s council of science advisers.
An equally stellar list of scientists are conspicuous by their absence. One, biochemist Jennifer Doudna of the University of California, Berkeley, supports “strict regulation that precludes use” of germline editing until scientific, ethical, and societal issues are resolved, she said in an interview. “I prefer this to a ‘moratorium’ which, to me, is of indefinite length and provides no pathway toward possible responsible use.”
Doudna, Charpentier’s collaborator on the 2012 paper that kicked off CRISPR genome editing, and some other CRISPR experts argue that “an effective moratorium” has been in place since 2015. “We have a moratorium,” said Lander. “Everybody has said we shouldn’t be doing genome editing at this time.”
In fact, neither the first international genome editing summit, in Washington in 2015, nor the second, in Hong Kong last November, where He announced his experiment, called for a moratorium.
“We have consciously not used the word ‘moratorium’ because people mistake it for a permanent ban and it would be hard to reverse,” said David Baltimore of the California Institute of Technology, who chaired the organizing committees for both summits. “A moratorium limits your options and doesn’t send the message that people might benefit from this one day. The present call for a moratorium strikes me as the wrong approach,” said the Nobel laureate, who in Hong Kong gave an impassioned denunciation of He’s work.
Baltimore calls the disagreement semantic, and denied that he and Lander, with whom he discussed the Nature paper before its publication, differ in a fundamental way. The official statements from both genome summits, as well as an influential 2015 essay by Baltimore, Doudna, and 16 co-authors urging a “prudent path forward” for germline editing, all noted numerous criteria that would have to be met for clinical germline editing (that is, to make babies, not as part of basic research without a pregnancy) to proceed.
Although Baltimore argues that those statements “were unambiguously designed to say we were not ready to move forward,” the most forceful recommendation in the “prudent path” paper was that countries should “strongly discourage” germline editing until “responsible uses” of it, if any, are identified.
Words matter, said science historian Ben Hurlbut of Arizona State University, who had numerous discussions with He before “Nana” and “Lulu” were created.
“My impression is, if ‘moratorium’ had been used, meaning a categorical prohibition on germline editing for reproduction, it wouldn’t have happened,” Hurlbut said. Instead, He weighed the criteria for germline editing in the 2015 summit statement, the “prudent path” paper, and a 2017 National Academies report and “believed he had checked all the boxes,” Hurlbut said, including that the procedure was safe, effective, and addressed a serious unmet medical need.
None of that was true, but the absence of a blanket moratorium — even when confidantes urged He not to proceed — allowed him to follow his own subjective judgment and self-interest.
Expert opinion nonetheless remains divided on the wisdom of a moratorium.
Opponents fear that a formal ban, perhaps backed up with country-by-country laws prohibiting germline editing for baby-making, would be hard to undo. The current “effective moratorium,” as Doudna calls it, the one every scientist supposedly recognizes, can more easily melt away if the regulated community itself — genome scientists — reaches a consensus that the technique has cleared the hurdles of safety, efficacy, benefit, and societal support.
“We didn’t call for a moratorium because we didn’t think it was the right thing to do,” said Richard Hynes of the Massachusetts Institute of Technology, who co-chaired the National Academies 2017 report on genome editing. “We specified what would be required to move forward.”
“I don’t disagree with the call for an international framework to set standards for both the scientific hurdles and the ethical and social concerns,” said Harvard Medical School Dean Dr. George Daley. “But I’m concerned a moratorium complicates future discussions rather than clarifies them. How long should a moratorium last? How is it enforced? Who gets to decide when to rescind it?”
Others who question the value of a moratorium focus on whether it would even work, absent strict legislation, surveillance, and enforcement. “It’s not sufficient that everybody promises to do the right thing,” said Harvard biologist George Church. “You need an enforcement mechanism,” like radar guns that enforce speed limits. “Just calling for another moratorium is posturing.”
In contrast, scientists who support a moratorium point to He’s experiment as proof that what currently exists didn’t work.
“My reaction [to the Lander group’s call for a moratorium] was, thanks, guys, for accepting the sense of urgency we all feel and recognizing the threat that germline editing poses to the ethical uses of this technology,” said Fyodor Urnov of Seattle’s Altius Institute for Biomedical Sciences, an inventor of the pre-CRISPR genome editing technique called zinc fingers. “I hope there will be a country-by-country adoption of a moratorium and that that sets a high bar for lifting it.”
Sidestepping the debate over a moratorium, Lander said “the real question” is what countries do while it’s in effect. “We take for granted that countries will pass laws if they want to prevent” germline-edited babies, he said. (Clinical use of germline editing is already illegal in about 30 countries.) In addition, he said, the moratorium period should be used to establish an international framework by which countries could alert the world if they intend to allow CRISPR babies.
Currently, “we don’t have any framework to discuss that,” Lander said. “We have reports and summits and temporary committees, but no ongoing framework for how the world should think about this technology. There is no place to go if a country wants to say they’re considering this.”
None should do so, he and his colleagues wrote, without “a period of public notice (perhaps two years) of its intent to consider permitting” CRISPR babies, “robust international discussion about the pros and cons,” “evaluation of both the technical, scientific and medical considerations, and the societal, ethical and moral issues,” and determining that there is “broad societal consensus in the nation” to proceed.
They reject the idea of an international treaty banning the creation of germline-edited babies, saying a CRISPR-babies version of the global chemical and biological weapons treaty “is too rigid for clinical germline editing.”
A moratorium won’t stop rogue scientists, Lander acknowledged, but he dismisses the concern about it not preventing another Nana and Lulu as “irrelevant. A rogue action doesn’t change the world. The real issue is, will a country go down the path of [genetically] modifying people” via germline editing.
The mechanism he and his colleagues propose, they wrote, “will place major speed bumps in front of the most adventurous plans to re­engineer the human species.”

Amgen: new 4-yr outcomes study to examine long-term effects of Repatha

Amgen announced plans to conduct VESALIUS-CV, a multinational clinical outcomes study for Repatha which will involve at least 13,000 patients worldwide at high risk of experiencing a first cardiovascular event, despite optimized treatment with lipid-lowering therapy. The study will be the first to investigate long-term outcomes in this population with Repatha for a minimum of four years. enrollment for VESALIUS-CV is due to begin in the second quarter of 2019. The multicenter, double-blind, randomized, placebo-controlled, parallel-group outcomes study will include high-risk patients who have not yet had a heart attack or stroke, but have coronary, cerebrovascular or peripheral arterial disease, who may have had interventions, such as a coronary arterial bypass graft or stents, or who may have diabetes with indicators of increased CVD risk. “High cholesterol is the most important risk factor in coronary heart and vascular disease, but we know that recommended levels of LDL-C or ‘bad’ cholesterol are frequently not reached in very high-risk patients,” said Robert Giugliano, M.D., principal investigator and a senior investigator at the TIMI Study Group at Brigham and Women’s Hospital and Harvard Medical School. “The VESALIUS-CV study will explore the impact of evolocumab on major cardiovascular events, such as heart attack or stroke, in patients who are already receiving treatment for lipid lowering and cardiovascular disease, but remain at high-risk, allowing us to better understand the benefits of significant LDL-C lowering in multiple patient types.”

Voyager Therapeutics’ Huntington’s Disease treatment granted orphan status

The FDA granted orphan designation to Voyager Therapeutics’ treatment of Huntington’s Disease, according to a post to the agency’s website.

Novartis non-small cell lung cancer treatment granted orphan status

The FDA granted orphan designation to Novartis Pharmaceuticals’ treatment of non-small cell lung cancer with MET genomic tumor aberrations, according to a post to the agency’s website.

Friday, March 15, 2019

App to Detect Diabetes by Smartphone Fingertip Scan

Researchers have developed an algorithm using machine learning and smartphone-based photoplethysmography (PPG) to detect diabetes with “reasonable discrimination.”
Because one in three people with diabetes don’t know they have it, and it is a risk factor for cardiovascular disease, the researchers hope that one day the app can improve rates of diabetes diagnosis.
People would still need to visit their healthcare provider to confirm their findings and have regular blood tests.
The researchers used contact PPG to obtain waveforms of color changes in blood vessels with heart beat — which is also used by apps to measure heart rate — to develop the screening test for diabetes.
Specifically, they input waveforms from 54,269 people older than 18 years who transmitted their data from the Azumio Instant Heart Rate smartphone app (and about 2.6 million PPG waveforms) to the Health eHeart Study into a 45-layer deep neural network computer program to “train” the program to develop a better algorithm to predict diabetes.
“Our study is the first [such] proof-of-concept study,” lead author Robert Avram, MD, a cardiology fellow at University of California, San Francisco (UCSF), told theheart.org | Medscape Cardiology.
Avram will present the findings here at the ACC 2019 Scientific Session(ACC.19).
As a next step, the team is validating the algorithm in patients from two cardiovascular prevention clinics at USCF and in Montreal to see how the diabetes detected from the PPG signal compares with that detected from a blood glucose or HbA1C test.
“Right now we have 40 patients,” Avram said, “and we have an AUC that’s comparable to what was reported in the poster — 0.76 — so it’s performing just as well as in [diabetes] self-report.”
The team is also working with the company to integrate this algorithm into its heart rate app, and they are examining actions that a clinician should take when a patient comes in with an app-based positive test for diabetes.
This diabetes-detection app could potentially be available in the marketplace in 2 years, according to Avram.

Still Need Provider Visits

However, these are early days and consumers need to be careful when using healthcare apps, Nathan Wong, PhD, MPH, Heart Disease Prevention Program, University of California, Irvine, and a member of the ACC Prevention of Cardiovascular Disease Council, told theheart.org | Medscape Cardiology in an email.
“While these technological advances are promising, they need validation against gold-standard tests (such as HbA1C fingerstick testing in the case of diabetes) and, depending on the manufacturer and [type of test], they can vary substantially in terms in accuracy,” he noted. …

MedPAC: Docs Don’t Need Raise in Base Medicare Pay

Physicians’ current fee-for-service Medicare reimbursement rates can stay as they are in 2020, the Medicare Payment Advisory Commission (MedPAC) said Friday in its annual March report to Congress.
Under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress set a number of updates to the Medicare fee-for-service payment schedule in advance. In that schedule, physicians received a 0.5% increase each year from 2015 to 2019; no further increases are scheduled for 2020 to 2025. However, apart from those updates in individual fee-for-service payments, physicians can also earn bonuses of up to 12% — or penalties of as much as -4% — based on their performance in Medicare’s new pay-for-performance program.
“Overall, access to clinician services for Medicare beneficiaries appears stable and comparable with that for privately insured individuals,” the report authors wrote. “Other measures of payment adequacy are stable and consistent with prior years. Therefore, the Commission does not see a reason to diverge from the current-law policy of no update for 2020.” MedPAC also had agreed with the 0.5% increase for 2019.
Although physicians may find their overhead costs increasing more than the updates they’re receiving, all indicators are that this isn’t stopping them from seeing Medicare patients, MedPAC executive director Jim Mathews, PhD, told MedPage Today during a conference call with reporters.
“One of the factors that we look at is the relationship between the update in law relative to measures of costs physicians face,” he said. Although there may be some indications that physicians’ costs have increased, “all our other indicators of payment adequacy are positive with respect to beneficiary access, physician participation, and quality of care.”
“There is always an element of judgment that comes into these determinations, but … the first question we ask is, ‘Is any update warranted to ensure beneficiary access, and if so, what should that update be?'” he continued. “Here, when we look at the preponderance of indicators in the physician sector, the commission came to the conclusion that the update would not be warranted or necessary this year in order to maintain access. But it is something we do explicitly consider in coming to these recommendations.”
The commissioners did take issue — but only slightly — with Congress’s proposed increase for Medicare hospital payments of 2.8%. “When we look at the number of hospitals participating, the volume of service, beneficiary access to care, and quality of care, those indicators in the hospital sector are generally positive,” Mathews said. However, one indicator less positive over the year [is hospitals’] Medicare margin — how well they’re doing financially as a result of participating in Medicare.”
In particular, “in the last year or two, the margins for the group of hospitals we deem relatively efficient have also gone negative; they were at -2% in 2017,” he said. “The reason it’s concerning for us when their margins go negative is that our authorizing statute requires us to examine factors related to delivery of care, so when … a hospital is efficient and still can’t stay in the black, that’s cause for concern.”
To address that problem, “One approach would be to give a broad update across all hospitals,” but that’s expensive and might end up giving money to hospitals that don’t need it, Mathews said. So instead, “this year we took a two-pronged approach.”
The first part involves redesigning Medicare’s quality incentive program for hospitals. “Currently there are four such programs in operation … Some of these programs are duplicative, and they impose a fair degree of burden on hospitals, and there is some question about the utility of measures collected under these,” he said. “We recommended that these four programs be consolidated and streamlined in a method that doesn’t require much reporting burden at all.”
In addition, MedPAC recommended that money collected under two “penalty-only” reporting programs — the Readmissions Reduction Program and the Hospital-Acquired Conditions Program — be kept by hospitals, “with the money being redirected to hospitals that perform the best under Medicare,” said Mathews.
The second piece involves the update itself; instead of doing a 2.8% overall update, “we’d give all hospitals a 2% update and take the other 0.8% and distribute that through our revised hospital incentive program … so hospitals in the aggregate would get all of the dollars they would under current law but more of those dollars being distributed by the Medicare program to those hospitals performing the best on quality and cost metrics,” said Mathews. “We are helping the efficient hospitals and turning the tide on their financial performance.”
Other recommendations from the March report included:
  • No update for ambulatory surgery centers (ASCs). In balancing the goals of maintaining beneficiary access to ASCs, paying providers adequately, appropriately restraining spending on ASC services, and keeping providers under financial pressure to constrain costs, “the commission concludes that the ASC update for 2020 should be eliminated,” the report said. In addition, Mathews told reporters, the commission “recommended that the [Health and Human Services Secretary] collect cost data for ASCs to better establish their financial performance under Medicare.”
  • A 1.9% increase — consistent with the formula set up under the Protect Access to Medicare Act of 2014 — in payments for outpatient dialysis services. “All the indicators [for this sector] are positive,” said Mathews. “We see the capacity of providers and the volume of services growing pretty much in lockstep with the number of beneficiaries with end-stage renal disease who need these services.”
  • A 5% decrease in the base payment rate for home health services. “There is very strong access to care as measured by the capacity and supply of providers,” Mathews said. “We had a slight decline in volume in 2017 but we believe this reflects a number of efforts, including some [Medicare anti-fraud] efforts.” Although quality of care indicators were mixed, “[there is] very strong financial performance under Medicare with a 2017 margin of 15%.”
The next MedPAC report will be issued in June.